Aalborg Universitet

Process evaluation of a Toolbox-training program for construction foremen inDenmarkJeschke, Katharina Christiane; Kines, Pete ; Rasmussen, Liselotte; Andersen, Lars PeterSønderbo; Dyreborg, Johnny ; Ajslev, Jeppe; Kabel, Anders; Jensen, Ester; Andersen, LarsL.Published in:Safety Science

DOI (link to publication from Publisher):10.1016/j.ssci.2017.01.010

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Publication date:2017

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Citation for published version (APA):Jeschke, K. C., Kines, P., Rasmussen, L., Andersen, L. P. S., Dyreborg, J., Ajslev, J., ... Andersen, L. L. (2017).Process evaluation of a Toolbox-training program for construction foremen in Denmark. Safety Science, 94, 152-160. DOI: 10.1016/j.ssci.2017.01.010

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Safety Science 94 (2017) 152–160

Contents lists available at ScienceDirect

Safety Science

journal homepage: www.elsevier .com/locate /ssc i

Process evaluation of a Toolbox-training program for constructionforemen in Denmark

http://dx.doi.org/10.1016/j.ssci.2017.01.0100925-7535/� 2017 The Authors. Published by Elsevier Ltd.This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).

⇑ Corresponding author.E-mail address: kcj@nrcwe.dk (K.C. Jeschke).

Katharina Christiane Jeschke a,⇑, Pete Kines a, Liselotte Rasmussen b, Lars Peter Sønderbo Andersen c,Johnny Dyreborg a, Jeppe Ajslev a, Anders Kabel d, Ester Jensen e, Lars Louis Andersen a,f

aNational Research Centre for the Working Environment, Lersoe Parkalle 105, Copenhagen DK-2100, DenmarkbNIRAS, Sortemosevej 19, Alleroed DK-3450, DenmarkcDanish Ramazzini Centre, Department of Occupational Medicine, Regional Hospital West Jutland, Gl. Landevej 61, Herning DK-7400, Denmarkd Team Working Life, Høffdingsvej 22, Valby DK-2500, DenmarkeMetroselskabet/ Hovedstadens Letbane, Metrovej 5, Copenhagen DK-2300, Denmarkf Physical Activity and Human Performance Group, SMI, Department of Health Science and Technology, Aalborg University, DK-9220 Aalborg, Denmark

a r t i c l e i n f o a b s t r a c t

Article history:Received 1 July 2016Received in revised form 16 January 2017Accepted 20 January 2017Available online 30 January 2017

Keywords:Toolbox meetingsToolbox talksLeadership trainingSafety trainingSafety communicationLean construction

Daily dialogue between leaders and workers on traditional construction sites is primarily focused on pro-duction, quality and time issues, and rarely involves occupational safety and health (OSH) issues. A lead-ership training program entitled ’Toolbox-training’ was developed to improve construction foremen’sknowledge and communication skills in daily planning of work tasks and their related OSH risks on con-struction sites. The program builds on the popular ’toolbox meeting’ concept, however there is very littleresearch evaluating these types of meetings.This article describes the development, implementation and feasibility of the Toolbox-training pro-

gram, and the results of the process evaluation and outcome evaluation. A total of 57 foremen from 12companies participated in the training in five successive groups during 2014–2015. Following each group,the program was continuously evaluated and revised until the final version after the fifth group. The eval-uation utilized an action research strategy with a mixed–methods approach of triangulating question-naire, interview, and observation data.Process evaluation results showed that the eight Toolbox-training topics were relevant and useful for

the majority of the foremen, who experienced positive changes in their daily work methods and interac-tions with their crews, colleagues, leaders, customers and other construction professions. The program isa unique contribution to leadership training in the construction industry, and can potentially be appliedand adapted in many other sectors. However, there is still a need for testing the long-term effects of theprogram on safety climate, injuries and business in future studies.� 2017 The Authors. Published by Elsevier Ltd. This is an openaccess article under the CCBY license (http://

creativecommons.org/licenses/by/4.0/).

1. Introduction

Accidents at work, physical attrition of worker’s health andearly retirement are problems that persist in the Danish construc-tion industry (Arbejdstilsynet, 2015). Construction workers are avulnerable group with more than twice as high a risk for work-related accidents compared with the average rate for all Danishindustries (Arbejdstilsynet, 2015). Work is often performed at mul-tiple job sites and the mix of contractors, trades, and workerschanges as projects progress, which provides many challenges in

implementing initiatives to promote safety and safety culture ingeneral (Lehtola et al., 2008).

Lingard et al. (2012) found that construction site supervisors aremore likely to have a significant impact upon safety, compared totop managers and safety managers. The quality and frequency ofsafety communication between foremen and their work crewsare associated with organizational safety practices and safety cli-mate (i.e. employees shared perceptions of safety priorities)(Zohar and Luria, 2003; Zohar, 2010). Safety climate has beenshown to predict employee safety compliance, participation andinjuries (Clarke, 2006; Gillen et al., 2002). Additionally, foremenare often an active part of the work crew carrying out workingtasks, and thus are the last link in the chain of formal decision-makers about the working environment and site safety.

K.C. Jeschke et al. / Safety Science 94 (2017) 152–160 153

Construction project Start-up meetings and/or risk evaluationsare often carried out prior to engaging in projects and tasks, whichinclude a focus on improving occupational safety and health (OSH).A traditional way of communication are toolbox meetings (toolboxtalks, tailgate meetings, etc.), which are a popular tool used in con-struction (and other industries) in many countries (Esmaeili andHallowell, 2012; Hinze, 2003). These brief meetings typicallyinvolve a foreman’s preparation and delivery of a specific OSHtopic with his/her crew (e.g. safe use of machines, PPE, etc.) beforework or during breaks. However, foremen and workers often endup having to make many crucial OSH decisions on a daily basis,and the daily OSH communication between a foreman and hiswork crew, colleagues, leaders, customers and other constructionprofessions mainly addresses production issues and deadlines(Dyreborg et al., 2008; Kaskutas et al., 2013).

Although toolbox meetings are a valued form of safety commu-nication in construction, research evaluating current practices isrelatively rare. In their review of the literature, Olsen et al.(2016) found seven studies/papers related to the perceived impor-tance, effectiveness and quality of toolbox meetings in construc-tion and five articles related to the need for materials. Only oneexperimental field study evaluated a toolbox meeting intervention(Harrington et al., 2009). In the study, Harrington et al. (2009)developed and evaluated a program to train construction supervi-sors in giving more effective toolbox meetings.

Research on current practices suggests that there are opportu-nities for improving the frequency and quality of safety meetings(e.g. toolbox talks, toolbox meetings). However, some safety meet-ings are management-driven with little engagement of workers(Mäki and Koskenvesa, 2012). Thus, there is a need for furtherresearch on effective safety communication interventions in theconstruction industry.

The current project was designed to develop and evaluate a’Toolbox-training’ program in Denmark with focus on improvingconstruction foremen’s competencies to enhance effective plan-ning and site safety practices, and to improve daily safety commu-nication (Finneran et al., 2012). The Toolbox-training program goesbeyond actual toolbox meetings, and focuses on foremen’s plan-ning, safety communication and safety work site behavior through-out the working day, not only at fixed meeting times, but also indaily ad hoc meetings and discussions. The program is focusedon increasing workers’ active participation and improving two-way communication. Forck (2005) and Williamsen (2003) identi-fied methods, recommended by safety professionals, to engageworkers or subcontractors, which include asking open-ended ques-tions and making action plans with follow-up, which wereincluded in the current training program (described below)(Forck, 2005; Williamsen, 2003).

1.1. The Toolbox-training program

The Danish Toolbox-training program aims to improve con-struction foremen’s knowledge and skills in planning and safetycommunication, not only with their crew members, but also withtheir colleagues, leaders, other professions and customers. In thefuture, the goal of the training program would be to reduce phys-ical attrition of workers’ health and improve injury and accidentprevention, health and safety culture.

More specifically, it is assumed that the program will promotesafety communication on a daily basis between foremen and thevarious parties on site, which will improve cooperation betweensite members and increase their individual participation in OSHdialogue. Participation is proposed to then increase the foremen’sand site member’s influence on planning and safety procedures,which improves the promotion of OSH and safety culture on con-struction sites and subsequently results in improved business.

Fig. 1 provides a model showing the study’s underlying programtheory, which is the relationship between the Toolbox-trainingimplementation and the Toolbox-training outcomes. The modelincludes process evaluation components to assess training imple-mentation, activities and activity outputs, and the short-term andintermediate outcomes that are precursors to the expected long-term outcomes (Edberg, 2007). The large arrow indicates theexpected pathways through the training program. The secondrow shows variables for each component of the model, with bidi-rectional vertical arrows to indicate an iterative process of feed-back and adjustment (Campbell et al., 2000).

The purpose of this paper is to describe the design and develop-ment of the training program, the process evaluation as well as anoutcome evaluation based on a theory-driven evaluation as out-lined in the program theory. An action research strategy was taken,applying mixed methods in the evaluation. This is in contrast to astringent effect evaluation and a method-driven evaluation whichtend to minimize or ignore stakeholders’ views and concerns in theevaluation.

2. Materials and methods

2.1. Study population

The study is based on 57 construction industry foremen (with2–25 work crew members each) who participated in the trainingin five successive groups during 2014 and 2015. Following eachgroup, the program was continuously evaluated and revised untilthe final version after the fifth group. The foremen representedtwelve different construction companies covering two geographicregions in Denmark (Jutland and Zealand), and who worked in var-ious construction trades (e.g. earth and concrete, masonry, carpen-try, scaffolding, demolition). The research group approachedfourteen companies’ OSH directors, who forwarded the informa-tion to construction site managers and their foremen. An informa-tion and recruitment flyer was distribution and an article in a tradespecific newspaper to attract participants. Recruitment of compa-nies was also done in collaboration with the project’s advisorypanel consisting of representatives from employer and employeepolitical organizations, OSH consultants and construction compa-nies (e.g. with the companies informing their subcontractors).Due to this small, conveniently sampled study population, simpledescriptive statistics within Excel were used to describe the data,as advanced statistical analyses would not have been appropriateor meaningful.

2.2. Toolbox-training program

A 22½ hour classroom program was developed by the projectteam and was carried out over five half-days (4½ hour per day),with two weeks of on-site training between training days, for atotal program length of nine weeks. Training was provided byexternal training consultants (familiar with providing trainingcourses in construction), and consisted of a mixture of theoreticallectures, practical casework and role-play, exchange of knowledgeand experience between the participating foremen, as well asassignments to be carried out during the two weeks between eachclassroom session. The external consultants used a manual for theToolbox-training program (train the trainer), which the projectgroup developed together with the other training materials. Train-ing focused on the central role of the foreman and the importanceof dialogue, involvement and influence of employees (and otherparties) to improve the daily OSH communication and planningof pre job and future tasks, and the managing of work relatedOSH risks. Foremen were to use the new skills and knowledge in

Fig. 1. Toolbox-training program: Core elements and expected pathways to improve occupational safety and health.

154 K.C. Jeschke et al. / Safety Science 94 (2017) 152–160

their daily activities with their work crew(s). Two project research-ers (authors 1 and 2) followed the training program and visitedselected participants throughout the program period to facilitatethe implementation.

The training included the following eight topics with their cor-responding eight tools:

� Foreman roles and responsibilities.� Communication (questioning techniques and feedback).� Body language (nonverbal).� Cross-cultural communication.� Conflict management.� Leadership and cooperation.� Planning systems (an adapted lean construction model).� Prevention of injury and work related disease, as well asimproving OSH on construction sites.

Hardison et al. (2014) confirmed that knowledge of pre jobplanning, organizing work flow, and establishing effective commu-nication are highly important competencies for the constructionforeman to possess. Gambetese and Pestana (2014) showed thatthe application of lean construction principles naturally led toenhanced worker safety (Gambetese and Pestana, 2014). Hinze(1981) found that leaders who expressed respect for workers andincluded their suggestions also had safer work crews. Shohet andLaufer (1991) showed that enhanced planning by the constructionforeman led to improved productivity and safety at the job site.

Based on this the Danish Toolbox-training program focused onimproving construction foremen’s knowledge of planning andorganizing pre-job and coming work tasks and their related OSHrisks on site to enhance work flow and site safety.

Another key element in the training was improving communi-cation skills (verbal, non-verbal, cross-cultural) to establish effec-tive safety communication between workers and foremen, aswell as between foremen and their colleagues and top managers.Kines et al. (2010) recommended that foremen need to be trainedin their safety communication with workers, but also in communi-cating to their superiors. Safety communication was proposed tohave positive effects on safety performance within the organiza-tion (Burke et al., 2011).

The training also focused on enhancing leadership and cooper-ation skills, as positive relationships improve job performance, jobsatisfaction and safety performance (Michael et al., 2006). Involv-ing employees (colleagues, leaders, customers and other construc-tion professions) in the daily planning process and incorporatingworkers suggestions were fundamental elements in the trainingprogram.

Alongside with the above mentioned competencies Hardisonet al. (2014) identified the importance for foremen to be competentin directing workers tasks and responsibilities, in order to increasethe safety performance of the work force and to demonstrate thevalue of safety, thus reflecting the foreman’s true commitment.Therefore, the Toolbox-training was designed to improve fore-men’s awareness as safety role models and their active participa-

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tion in safety planning. Peterson (1999) found that when leadersvisibly participate in safety policies workers saw safety as a princi-pal organizational priority.

Another focus area in the training was to improve conflict man-agement competencies. Conchie et al. (2011) and Odiorne (1991)recommended that a foreman should possess the knowledge andskills to identify escalating conflicts and how to resolve them.Brockman (2012) found that interpersonal conflict had a substan-tial negative effect on construction projects and its financial costs.Training in conflict management was thus proposed to reduce theincidence of interpersonal conflicts on the construction sites.

Finally, Toolbox-training was designed to improve foremen’sknowledge to prevent occupational injuries and work related dis-ease, as well as to improve OSH on construction sites. This includedknowledge of identifying and managing health hazards, as well asstrategies to control and prevent these hazards (Arbejdstilsynet,2014).

2.3. Design of the process evaluation

The study included a detailed process evaluation of the trainingprogram which serves both a formative and a summative purpose.The formative evaluation strengthened the training program andhelped form it by examining the delivery of the program, theassessment of the organizational context, personnel, proceduresand inputs. The formative purpose involved a continuous use ofprocess data and feedback from the participating foremen for opti-mizing training through learning, and determines if the trainingneeded modifications.

The aim of the summative purpose was to determine whetherthe training was implemented as intended, to provide guidancefor future interventions, and to evaluate the impact of theToolbox- training on short-term and intermediate outcomes.

The process evaluation followed the framework introduced bySaunders et al. (2005), which is based on work by Steckler andLinnan (2002) and Baranowski and Stables (2000). According tothe above-mentioned framework the following components arerecommended to be included in process evaluations, and are usedhere to measure intervention activities and activity outputs:recruitment, reach, dose-delivered (completeness), dose-received(exposure), fidelity (quality), satisfaction, and context (barriers andfacilitators). The process evaluation components used in this studyare defined as follows:

Recruitment was defined as the sources and procedures used toapproach and attract foremen for participation in the Toolbox-training. All foremen were informed about the main objectiveand content of the research project and participated voluntarily.The program was free, and foremen received permission from theircompanies to participate during their working hours.

Reach was defined as the proportion of foremen who wereapproached for participation in the Toolbox-training. In the presentstudy the intended audience was construction foremen in Den-mark with staff management responsibilities (e.g. to lead a workcrew), and a certain level of financial as well as operationalresponsibility.

Dose-delivered was the proportion of the pre-planned Toolbox-training days which was actually provided by the training consul-tants to the participating foremen. In this study five classroomtraining days were planned to be provided to each of the five train-ing groups.

Dose-received was the proportion of participants showing up forthe training days.

Fidelity was the extent to which the intervention was imple-mented as planned. In this study participants were to implementthe training tools themselves during the two-week on-site training

between each of the five classroom training days. Additionally, twoproject researchers followed the implementation process through-out the training period to facilitate implementation. We measuredto which extent foremen were engaged with, and used materials ortools from the training using self-report survey items (e.g. useful-ness of training tools), and interviews with selected foremen.

Satisfaction was defined as the foremen’s opinions and attitudestowards the Toolbox-training. We used interview data to describethe participants’ experiences.

Context was defined as factors (e.g. aspects of the larger socialand political environment) which either hindered or facilitatedthe implementation of Toolbox-training. We used field notes andinterview data to describe the context surrounding the trainingand participating construction sites.

Finally, we evaluated the impact of the Toolbox-training on thefollowing short-term and intermediate outcomes.

Short-term impacts included learning constructs of skills, knowl-edge, awareness and attitudes towards the training activities andactivity outputs. Skills were measured by the foremen’s ability tocommunicate and engage with his work crew in safety dialogue,to plan work tasks safely and to lead by example (e.g. find solu-tions, motivate crew members to work safely). Knowledge (e.g.knowing when and how to use training tools, identifying safetyrisks), awareness (e.g. ability to point out why work tasks are phys-ically demanding or unsafe) and attitudes (e.g. willingness to trynew tools) were measured using survey items, interviews and fieldnotes.

Intermediate impacts were assessed by foremen’s behaviors,practice and participation of work crew members & others. Datasources included surveys in which foremen were asked to reporttheir individual use of Toolbox-training tools, observations andinterviews with selected foremen and work crew members.

We summarized all evaluation elements into five main researchquestions for the process evaluation:

(1) Was the expected target population reached? (reach,recruitment). (2) Was the program implemented as intended?(fidelity, dose-delivered, dose-received). (3) How did the foremenand their work crews experience the training? (satisfaction). (4)How was the implementation influenced by contextual factors?(context). (5) What impact did the training have on foremen’slearning (short-term outcomes) and actions (intermediateoutcomes)?

By documenting all of these aspects of the implementation pro-cess we were to asses to what extent the implementation was suc-cessful. In the case of a successful implementation, we examined ifour program theory (Fig. 1) could be confirmed, that is, if the orga-nizational intervention of the training program led to the expectedshort-term and intermediate outcomes.

2.4. Data collection procedure

To carry out this process evaluation we used three data sources(triangulation) with a mixed-method approach: repeated self-report surveys for all participating foremen before and after thetraining, semi-structured interviews with selected foremen andtheir work crew members (and where relevant - leaders and col-leagues) before, during and after the training. Due to this being adevelopmental project, the semi-structured interviews allowedfor the addition of new topics/issues. Additionally, we listened toand observed the foremen during the training days and at theirconstruction sites (Waddington, 1994). The information from thesedata sources were used to assess the implementation according tothe above-mentioned framework, and enabled the identification ofconfirmatory or conflicting issues. The data triangulation alsoenabled the identification of patterns in all the collected data, in

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order to develop an overall interpretation, including multipleviews on the implementation process. In the following, the maindata sources for the process evaluation are explained more in-depth.

2.4.1. Questionnaires for participating foremenWe distributed a short online questionnaire to participating

foremen from group 2 to 5 before (n = 48) and after (n = 43 fore-men, who participated at least four out of five times) the training.The questionnaires were distributed at baseline (T0), directly at theend of the fifth training day (T1) and after respectively 2–10 months (T2) after the training (group 2: after 10 months, group3: after 7 months, group 4 and 5: after 2 months). We assessed towhat degree foremen gained new knowledge, new skills, higherrisk awareness, to what degree the different training tools wereexperienced as useful on site, to what degree foremen experiencedpositive changes in organizing work tasks and participation ofwork crew members, etc.

2.4.2. Individual interviews with participating foremenIndividual semi-structured interviews (n = 20) with selected

foremen were conducted before, during (n = 23) and after thetraining program (n = 15 telephone interviews). The interviewswere transcribed and thematically coded based on the researchquestions and the process evaluation components. We assessedto what degree and why different training tools and skills were uti-lized, barriers and facilitators for the implementation of theToolbox-training (context), to what degree the foremen were satis-fied with the training program, and if the training was imple-mented (fidelity and dose delivered). We asked how oftenforemen talked to their crew members, which topics they dis-cussed and to which extent the foremen experienced a change inthe communication, participation and OSH behavior of their workcrews.

2.4.3. Individual interviews with selected work crew membersIndividual semi-structured interviews (n = 36) with selected

work crew members were conducted before and after the trainingprogram. Additionally, the training consultants answered ques-tions about the content structure of the training program, andusability of methods and materials in order to optimize theprogram.

2.4.4. Development processImportant data was gained through an interactive and iterative

development process of the training program. The formative pur-pose of the process evaluation involved a continuous use of feed-back from the participating foremen. We involved all participantsand used their feedback to develop and optimize the content andframework of the training program. Thus, the program was succes-sively adjusted between the five different groups.

We (authors 1, 2 & 4) observed foremen’s participation, engage-ment, behavior and attitude towards the training in the classroom,and visited a representative sample of them at their constructionsites to see if and how they applied the knowledge and skills fromthe eight topics and tools. We assessed the degree of safety com-munication, which materials (e.g. leaflets, copies) were distributedto the work crews, whether communication type (e.g. dialogue)and content had changed (e.g. safety and health topics), whetherforemen used training tools on site, and we linked foremen’sbehavior during the five training days to this utilization (dose-delivered to work crew members).

3. Results

We used the program theory (Fig. 1) to demonstrate the use ofprocess evaluation to optimize the training program. In order toillustrate the application of the program theory to the interventionresults, we provide examples of process evaluation outcomes andanswers to each of the five research questions.

3.1. Was the expected target population reached?

Recruitment: Twelve out of fourteen companies sent foremen to

participate in the Toolbox-training program. Thus, reachwas 85.7%.However, we were unable to successfully recruit foremen frommicro and small companies with less than 100 employees.

3.2. Was the program implemented as intended?

Dose-delivered was 100%; that is, four different training consul-tants delivered all five training days to each of the five traininggroups (one trainer delivered 2 of the programs). A total of 57 fore-men participated in the training program, but only foremen whoparticipated in at least four out of the five training days, were

included in the process evaluation. Dose-received was 86% for allfive groups (i.e. 49 out of 57 foremen).

High fidelity was given if participants: gained more knowledge/skills, were actively engaged with the training, and/or used thetraining tools/materials on site. The results provided evidence thatthe training topics were relevant and useful for the foremen intheir everyday interactions with their crews, colleagues, leaders,customers and other construction professions. Directly at the endof the fifth training day foremen were asked to what degree eachof the topics/tools were relevant for their daily work on site(Fig. 2). Over 80% of the foremen found that all eight trainingtopics/tools were to a ‘‘high” or ‘‘very high” degree relevant fortheir work, particularly the tools regarding ’Conflict management’,’Communication’ (both verbal and nonverbal), ’Planning systems’and ’Foremen roles and responsibilities’. These were followed byfairly similar results for the latter three topics/tools regarding’Cross-cultural communication’, ’Prevention of injuries & workrelated disease’ and ’Leadership and cooperation’. One formativeoutput was to modify the training if needed, e.g. ‘‘How to hold atoolbox meeting” was one of the topics with the first group, butwas removed as the participants did not feel a need for havingmore structured meetings with their work crews, but rather tobe more effective in their current formal and informal (ad-hoc)daily communication with both their crews, colleagues andleaders.

Results showed that more than 50% of the 36 foremen, surveyed2–10 months post-intervention, still used various training tools toa ‘‘high” or ‘‘very high” degree. Particularly the questioning tech-niques and feedback (verbal communication tools), as well as ’Bodylanguage’ and ’Foremen roles and responsibilities’ were among themost used tools (Fig. 3). Due to nonresponse and employee turn-over only 36 of the 43 foremen (43 foremen from group 2 to 5)answered the follow-up surveys.

Inclusion of OSH in their daily planning and communicationwas seen as giving added value to their work and their projects.The results showed that the degree of knowledge regarding plan-ning, health, attrition and safety communication increased, andthat participant’s attention to their role as foremen, safety engage-ment, risk awareness, and assignments of leadership responsibili-ties increased from before to after the training.

Fig. 2. Relevance of Toolbox-training topics/tools directly at the end of the fifth training day (n = 43 foremen from groups 2 to 5).

Fig. 3. Usefulness of Toolbox-training topics/tools 2–10 months post-intervention (n = 36 foremen from groups 2 to 5).

K.C. Jeschke et al. / Safety Science 94 (2017) 152–160 157

3.3. How did the foremen and their work crews experience thetraining?

Foremen reported back that they gained knowledge and skills toengage with work crew members in daily safety dialogue, and theaugmented communications skills were used to improve work task

planning (satisfaction).One foreman responded during the training as follows: ‘‘I will

calculate our overall noise level on site. I think there is much focuson work accidents, but after what we have talked about today, I wantto focus more on occupational diseases.”

Moreover, the foremen utilized the given training materials intheir daily work, e.g. training templates were posted in the on-site workers’ hut, or were used for joint reviews of work taskstogether with the work crew. The foremen used their improvedcommunication skills just as much with their own leaders, col-leagues and clients, as they did with their own work crew(s).One foreman reported back as follows:

‘‘After Toolbox-training I have become much more conscious aboutusing open-ended questions, and to ensure participation. Especiallywith conflict management – escalation and resolution [one of thetraining tools] has been good. It has been particularly useful, sinceI had to use it for negotiations with management about pieceworkcontracts. But I also use it in everyday situations. For example, wehave challenges with our foreign subcontractor, who is responsiblefor demolition, and in other cases we have issues with residents - inboth cases I made sure I involved construction site management insolving the problem.”

Foremen reported that they had a better understanding of theirrole as foremen, they felt more responsible for communicating andmediating safety information between management and crewmembers, and they understood their position as role models toimplement changes. They were also highly motivated to facilitatechange, e.g. one foreman delivered an action plan on how to moti-vate and involve his work crew more frequently by giving his workcrew more responsibility in making decisions. His crew membersformed an internal working group to plan social activities, and theychose a contact-person in addition to the crew boss to reduce thework load on the foreman’s shoulders.

In the beginning, foremen experienced that involving crewmembers in dialogue and asking open-ended questions was awk-ward and a threat to the ‘power relations’, but recognized a posi-tive change in their work crews’ reactions and that it reducedtheir own work load. After completing an assignment on site oneforeman reported the following:

‘‘Instead of delegating the work, I asked who would take care of it.There was a pause and that was somewhat awkward. I said this isup to you today. There was a person who volunteered. . . that itwould be ok. One may take too much responsibility. If you can’tdo that [let employees take initiative and responsibility] you willhang on the phone all day [making decisions for them], it’s greatwhen they [work crew] can [take responsibility]. It must also begood to take responsibility.”

The selected work crew members that were interviewedreported back that they felt involved in decisions when the fore-

Fig. 4. Toolbox-training: Positive changes in work methods 2–10 months post-intervention (n = 36 foremen from groups 2 to 5).

158 K.C. Jeschke et al. / Safety Science 94 (2017) 152–160

man asked them open-ended questions without giving answersbeforehand, and when using the planning system tool togetherwith other members of the work crew.

3.4. How was the implementation influenced by contextual factors?

The context includes factors that did not result from the train-ing program, but which may have influenced delivery and can beseen as another formative output. The participants’ individualattitude and opinion towards the training and need for changewere, in some cases, contextual barriers, which hindered theimplementation of the effects of Toolbox-training. Not all partici-pants used the training tools after completion of the program,and not all foremen liked to ask work crewmembers for their inputand opinions. One foreman used the planning system tool, but didnot involve his work crew in the planning process. He did not feelthat employee involvement was necessary based on his under-standing of a foreman as an ’in-control organizer’, who does notask questions but provides instructions. Another barrier was thehigh turnover among work crew members, e.g. one foremanreported back that he borrowed manpower from other foremen:

‘‘It’s easier to use that [Toolbox-training tools] with people whoare your own. It’s a waste of time to use a personality type tool[leadership and cooperation training tool] or questioning tech-niques with them, as they disappear again.”

Work crew members reported that other hindering factorswhich affected OSH dialogue and knowledge sharing negativelywere the lack of interest among their colleagues, tight time sched-ules, busy foremen talking on the phone and not being able to gettheir foreman’s attention. Communication barriers with foreignsubcontractors were also experienced as a challenge, and we opti-mized the Toolbox-training program addressing these cultural andlanguage challenges by adding a new training topic: cross-culturalcommunication for groups 4 and 5, which can be seen as anotherformative output.

3.5. What impact did the training have on foremen’s learning andactions?

3.5.1. Short-term impact: learningAnalysis of repeated surveys, interviews and field notes showed

that foremen were more aware of their role as a leader (e.g. to leadby example), and as to why crew members needed individuallytargeted OSH communication (e.g. motivate crew members towork safely). Foremen felt knowledgeable about communicationand planning work tasks safely (e.g. knowing how and when touse training tools, identifying safety risks), they had a positive

attitude towards applying new training tools (e.g. willingness totry new tools), and were aware of OSH risks in their work tasks(e.g. ability to point out why work tasks are physically demandingor unsafe).

3.5.2. Intermediate impact: actionsThree-quarters of the 36 foremen experienced positive changes

in their work methods and organizing work tasks (e.g. inclusion ofOSH in planning processes, improved cooperation among workcrew members and between work groups from different construc-tion trades) (Fig. 4). The inclusion of OSH in planning processes andcooperation between work groups scored highest with more than80% of all foremen recognizing positive changes in work methodsto a ‘‘very high” or ‘‘high degree”. Improved cooperation includede.g. better communication between work groups due to question-ing techniques which led to an understanding of other workgroups’ behavior. More than 70% of the foremen also changed theirwork methods regarding the use of technical equipment, and theyreported that they encouraged their work crews to use the appro-priate equipment.

Process evaluation results showed that 90% of the 36 forementalked ‘‘Always” or ‘‘Often” about ‘‘Planning” and ‘‘Production”with their work crews. However, over 40% talked ‘‘Always” aboutthe ‘‘Use of protective equipment” and 38% talked about ‘‘Safety”every time they met with their work crew. Kines et al. (2010) foundthat construction site workers perceived safety as part of their ver-bal communication with their foremen in only 6–16% of their dailyexchanges. Our results indicated that some foremen’s communica-tion type (e.g. dialogue) and content had changed (e.g. safety andhealth topics) over time. Other foremen reported no behavioralchanges, and referred to the various barriers to implementing thetraining tools as described above under ‘‘context”.

4. Discussion

This study provides evidence that the concept of toolbox-meetings can be expanded to a ’Toolbox-training’ program and isadaptable to the construction safety culture in Denmark to suc-cessfully improve OSH dialogue among foremen and other partieson construction sites. A program theory (Fig. 1) was applied to thedesign of the training program, and was found useful in describingthe training program plan and in providing feedback on itsdelivery.

The programwas well-received among foremen, and there weresome indicators of improvements in planning and safety commu-nication among the foremen and their crew members. Similarstudies have found that toolbox meetings improved knowledgeand behavior among employees (Hinze, 2003; Dedobbeleer and

K.C. Jeschke et al. / Safety Science 94 (2017) 152–160 159

German, 1987; Kaskutas et al., 2013). Toolbox meetings, with focuson fall prevention, suggested that safety communication traininghad an effect not only on participating foremen, but also on youngapprentices’ safety practices and at the worksites that the foremendirected (Kaskutas et al., 2013). Kines et al. (2010) showed thatconstruction site safety improved when foremen increased verbalsafety dialogue. Workers have an informal and oral culture of risk,in which safety is rarely openly expressed. Increased communica-tion skills (verbal, non-verbal, cross-cultural) to establish effectivesafety communication between workers and foremen, as well asbetween foremen and their colleagues and top managers, are cen-tral to improve safety.

Foremen play a central role when it comes to engaging workcrew members actively in dialogue and problem-solving discus-sion on site. They can help to optimize safety in an otherwisedynamic industry, where people and processes change constantly.Given that feedback from leaders and recognition are amongst themost powerful incentives influencing job performance (Stajkovicand Luthans, 2003), construction foremen should be trained howto teach their crew members and provide feedback to affect theirsafety behaviors (Kaskutas et al., 2013). Our study elaborates onthese previous findings by showing that the concept of toolboxmeetings can be successfully expanded to a Toolbox-trainingprogram.

Early findings from short-term outcomes indicated the foremenbenefited from the current Toolbox-training program; detailedanalysis of the long-term data will need to be evaluated in thefuture. In the training program, foremen learned from the training,improved their safety communication (e.g. asked workers for ideas,motivated worker participation in OSH dialogue), and attempted totake actions to involve their work crews in the planning process toreduce their risk of injury and attrition of workers health.

Impact on learning and actions are early indicators of efficacybased on the training program, and as mediators to the long-term outcomes enabled a description of why the training programdid or did not improve OSH (Edberg, 2007). It was important to usethe process evaluation to determine how Toolbox-training workedunder normal, everyday working conditions, as contextual factorsaffected the degree of implementation (Cole et al., 2009; Hengelet al., 2011). This demonstrates the value of describing the trainingprogram plan, using a process evaluation to determine what wasactually delivered, and interpreting both short and long-term databased on the delivered training program. The study showed thatthe training program is feasible. However, only half of the respond-ing foremen used the training tools after 2–10 months post-intervention. To increase the number of foremen using the toolsin their daily practice on site, even several months after the train-ing, the embeddedness of positive changes in organizations has tobe strengthened (e.g. through management support). In a futurestudy we will investigate which organizational conditions supportthe long-term embeddedness of the Toolbox-training program, anddata collection on long-term outcomes (injuries, site safety, safetyclimate, etc.) will need to be carried out.

A strength of this study is that we were able to address severalconstruction trades and that we developed a manual for theToolbox-training program (train the trainer), and therefore it caneasily be delivered in various construction groups, and adaptedto other industries. In the present study we purposefully used dif-ferent trainers with recent construction experience. Trainers withexperience and relations within the construction industryincreased the relevance of the Toolbox-training.

There were however, some challenges with the study. We oftentrained very experienced foremen, who had been on several train-ing courses, and who already had a high degree of OSH knowledge.The foremen were from twelve different construction companies,most of which were noted for having ambitious OSH programs.

Thus, the foremen’s responses may not be representative of con-struction foremen in general. For the purpose of optimizing theprogram, the selected target group was well chosen and gave valu-able feedback, which allowed for continuous improvement of theprogram. All foremen reported a high degree of knowledge transferwithin the group of participants, due to their different occupationalbackgrounds (e.g. different construction companies and variousconstruction trades). A limitation of this study is that we werenot able to recruit small and medium sized enterprises. Althoughthe principles of the Toolbox-training program may also apply tosmaller companies, finding the resources to participate in suchprograms may be challenging.

5. Conclusions

This study investigated the feasibility of the Toolbox-trainingprogram and to what extent the implementation was successful.The training program reached the expected target population(e.g. foremen), was delivered 100% (e.g. all five training days weredelivered to each of the five training groups), and 86% of the fore-men from all five groups attended the program. Therefore the pro-gram was implemented as intended.

The study identified training needs and opportunities for con-struction foremen and their work crews. Toolbox-training waswell-received among foremen, and their degree of OSH knowledge,planning and safety communication skills increased. Safety com-munication between foremen and their work crews improved, asinterviewed work crew members’ participation in OSH dialogueincreased, which made them feel more involved in decisionsregarding work tasks. The study suggests that work crews’ partic-ipation in safety communication and active employee involvementhas a positive impact on planning and OSH procedures. The major-ity of the foremen were actively engaged with the training, andused the training tools as well as materials on site 2 to 10 monthspost-intervention. As a result, the organizational intervention ofthe training program led to the expected short-term and interme-diate outcomes, which is why we confirm our program theory(Fig. 1).

However, foremen did not utilize all eight training tools andskills after the training program, and a change in a foreman’sOSH communication and behavior is not always evident for workcrew members. The most common factors, which hindered theforemen in applying their new knowledge and skills, were tightproduction schedules, turnover and lack of interest among workcrew members, and individual attitudes towards the training.

Determining the efficacy of the Toolbox-training programinvolves more than evaluating long-term outcomes. In preparingfor the diffusion of interventions in dynamically changing workenvironments, researchers must describe and measure their pro-gram implementation.

Acknowledgements

The authors would like to thank the 12 participating companies,57 foremen, 4 trainers, project team and Advisory Panel for theiractive engagement in the project. The project was funded jointlyby the Danish Working Environment Research Fund (project 41-2013-09) and the politically prioritized grant ‘‘New paths towardsincreased workability for vulnerable job groups”.

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